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Health Hack #58 - Fasting: The Ultimate Anti-Gorge

Initial Resistance to the Subject of Fasting

Of all of the subjects we've covered, publishing on a weekly basis for more than a year now, there is none that I've been grappling with more than the subject of this article...fasting.  

In this specific case, "fasting" implies the water only type that lasts more than 36 hours.  This is noteworthy, to differentiate what is truly intermittent fasting (the 36 hour or more version that we're discussing here) from time restricted eating, which we'll narrowly define as a daily eating window compressed into 12 hours or less.

To be abundantly clear and risk beating a dead horse - intermittent fasting (which we'll henceforth refer to as "IF" for the sake of brevity) describes the sporadic practice of fasting for extended periods of time, which we're defining as 36 hours or more.  Time restricted eating ("TRE"), which is often mislabeled as IF, is generally a daily practice with much more digestible parameters (pun intended), such as eating between the hours of 12pm-8pm and abstaining from eating for the other 16 hours of the day.  For a full article devoted to the subject of TRE click here.

Hopefully putting all semantic confusion behind us now, the reasons for the ambivalence in covering IF...

Despite being an adherent to IF for longer than this weekly blog has been churning out content, I was initially reluctant to cover the subject due to it's connotation of being wacky, and it's subject matter of being too fringe.  Aside from a close group of friends (including our co-owner) who have been tuned into the same channels as myself for many years, it struck virtually everyone I'd shared it with as being quite strange.  "You mean you're not eating?  For five days?  And it's because you believe that it's actually good for you, to go without food for that long?"  I could have been crass by way of being terse, and replied "yes, yes, and yes", because that would have been perfectly truthful.  But the more unconventional a routine is, the more explanation is typically demanded of those doing the prodding.  The conundrum with IF is that if you don't know anything about it, then you really don't know anything about it, because the physiological benefits are complex and requiring of a whole new vocabulary for most.  An internet search on the subject is bound to yield results in articles and videos from the world's leading experts on the subject, speaking to other world leading experts on the subject, and the intellectual ping pong is nearly impossible to keep pace with.  My hope is to provide a simple introduction to the subject by way of this article, and do so in as simple and coherent a way as possible.  I have the layman advantage of having done the research, but not having fully adopted the jargon often associated with it yet, giving me a nice ability to disseminate the information in a fairly coherent manner...or so I hope.

My second and more pressing hesitation is probably obvious after a moment or two of guessing.  As the owner of a business that sells food, it doesn't make much economic sense to espouse the virtues of avoiding food for a prolonged period of time.  This was more of an inner-company joke than a legitimate concern, but it did have some bearing on my decision to lay off the subject for a while.  

Why now?  Well, it's a nice companion piece to what we recommended around this time last year, which dealt with earning the extra calories by way of a specific exercise approach before a holiday gorge began.  In the case of the Thanksgiving feast, that opportunity is now gone.  As far as a hack on the back end, fasting provides an opportunity to re-establish equilibrium, and essentially balance things out.  This is a fairly cheapened use of its overall benefit, but it's as good of a reason to delve into the subject as I've had, given prior hesitations.  It's probably intuitive that a fast can help negate some misgivings that overindulging may provide, but what most people aren't aware of is the ability of fasting to provide much more benefit beyond that of working to shrink one's waist line back to baseline after going off the rails.

The Longevity Toolkit

There are three dietary methods known to increase lifespan across all known species.  From yeast all the way up to humans, these boil down to the use of a molecule known as rapamycin (science hasn't yet determined the proper dose for humans in pursuit of longevity benefits and therefore the molecule is not available in over the counter supplement form) caloric restriction, and fasting.

Rapamycin, the first modality, is far from mainstream, and bound to be quite pricy once it hits the market.  The second and third are available to us every waking day, and come at the luxury of costing nothing.  And when you evaluate the opportunity cost of practicing sporadic fasting, you can make the attractive argument that it actually saves you money.  What costs more: eating food or not eating food?

This sounds like a stupid point, but it speaks towards some of the nuanced benefits that might not meet the naked eye.  What is the true cost saving of employing a practice like IF longterm, if viewed through different lenses?  That's the important question to ask.  

Through an obesity lens, it poses immense opportunity towards benefit.  There is no predictor of downstream health complications more potent than suffering from obesity now.  Fasting has the luxury of baking one of the other lifespan hacks directly into it's cake, that being caloric restriction.  When you're not eating food, you're obviously not ingesting calories.  Therefore IF provides a wonderful one-two punch that can be pulsed sporadically, either on a regimented basis, or during random instances when one's diet has come a bit unhinged, like we often experience during the holidays.  Weight stabilization, despite it's impact from any fasting protocol being simple and obvious, must remain at the forefront of conversation surrounding IF.

There is plenty of didactic chatter in regards to how our choices in food, packaging, and now even with things like the cars we drive (emissions) effect our planet.  Well, obesity happens to pack quite the environmental gut punch as well.  We don't hear about it much because it's taboo to consider it in these terms, but environmentally speaking, Type 2 Diabetes is quite taxing.  When we consider the environmental cost of the production of insulin syringes, tubing, and all components associated with Dialysis treatments, we see an affront to our planet's sustainability.  Furthermore, we see economic ramifications both near and far.  From loss of productivity at work to increased health care premiums paid for by the employer, the obesity epidemic (nearly 70% of Americans are overweight, and more than 40% can be classified as obese, if you can believe it) needs to be discussed in this context.  If you think I'm sounding harsh, blame the Harvard review board that published the pragmatic findings.  Further downstream lie burdens on our national economy, where obesity-driven Type 2 Diabetes could potentially capsize our health care system as we know it, if trends continue as they've been.  If only more medical professionals could tune themselves into a preventative treatment that literally could not be more available, nor cost any less than IF.  

Anyone who has endured a fast extending beyond 36 hours (if you haven't, then simply take my word) knows full well of the strangeness incurred when the fast is first broken.  One would think that the appetite would be so immense that it could compel falling down a slippery slope and eating three meals worth of food in one sitting.  In fact, the opposite is true.  When it ceases being used as a processing plant perpetually filled to the brim, the stomach will literally shrink.  You'll find, as I certainly have, that enduring a multi-day fast only once per season (or four times per year) will yield a permanently lessened appetite, in comparison to prior baselines.  As someone who has personally held a ravenous appetite much of my life, I've found that I no longer need to engage in incessant exercise to justify the excessive calories.  Both my exercise intensity and duration have waned over the past two years, yet I've held the same base weight and muscle mass; and if anything I've managed to get leaner and stronger.  My body doesn't want those extra calories, as it clearly no longer needs them.  It's not a stretch to liken an IF protocol to a natural form of a mild gastric bypass surgery, the objective of the latter being to manipulate the size of the stomach as a cure for obesity when most other measures have failed.

Another important lens to view fasting through is that of time, in a variety of contexts.  I've found awe in the amount of time I realized that I had dedicated to eating, each day.  These are moments I thoroughly enjoy, so there was no eagerness to ditch them entirely; but it was eye-opening to learn how much free time opened up once food was no longer an omnipresent thought.  Between gathering whatever would be for dinner, preparing the actual dinner, eating the dinner, and then cleaning up afterwards, we can easily spend hours each day wrapped up in all things food.  I've found the occasional fast to provide a nice reprieve from all of these stringent time constraints, and I'll carefully time a fast during a period where I know I could use a few hours per day focused on something else.

Drawing on the seemingly silly short-term perspective of time saved like we noted with weight and waistline reduction, the longview is truly where the immense and enduring benefits of IF lie in respect to time, as with weight.

Autophagy (constant debate over proper pronunciation) equates to self ("auto") eating "phagy" in the context of cellular life.  Unknown to many is the fact that at some level, we're all living with cancerous cells.  The overwhelming majority of the time, our bodies are able to eradicate these malignant cells by way of natural processes.  One of these numerous processes is autophagy.

Boiled down, autophagy is a housecleaning process of our cells.  Consider a prognosis suggesting that one's cancer has metastasized.  In this scenario, narrowly housed malignant cells have had the opportunity to replicate and spread throughout other regions of the body.  Autophagy aims to blunt this process back at it's root, before these damaged cells are able to proliferate.  It does so by way of prompting healthy, high functioning cells to devour dysfunctional components of themselves or of other damaged cells, essentially providing a cellular cleansing service.

What does fasting have to do with autophagy?  The process of autophagy has an inverse relationship with a growth pathway called mTor (which we previously covered in some depth here).  mTOR is a fairly recent discovery, and one with vast importance.  It signifies a channel that works in different parts of the body (such as in the cell, and separately in the muscle) to promote growth.  We activate mTOR in our cells by way of ingesting calories (a.k.a. food), namely in the form of protein which comes ripe with many of the amino-acid building blocks needed for all things growth.  When mTOR remains activated, our cells are able to replicate somewhat indiscriminately.  When we turn that channel off, autophagy intervenes to more or less say "we're not going to grow right now; instead we're going to take this opportunity to clean house".  Fasting gives us the remote to be able to turn this mTOR channel on or off.  We need it on (at a cellular level) for the bulk of our lives, as cellular replication marks the very essence of what grants us survival.  But we don't need it on all of the time.  And if we pulse it elegantly, then we can maximize it's efficiency.  It's actually simpler than it may be sounding...

When we turn the channel known as cellular mTOR OFF, by way of engaging in a multi-day fast, cellular growth slows and cleansing becomes first priority.  Once we've cleaned house and strengthened our cellular population, we're in a position to turn mTOR back on.  When we do, we've drastically reduced the number of damaged cells in circulation, which in turn allows for the growth and proliferation of far more healthier cells than before we fasted.  When we're in a state of growth of any kind, we want the building blocks of that growth to be as healthy and stable as possible.  Autophagy, by way of IF, gets us there.  

It's generally agreed that by the 48 hour water only fasting mark, autophagy is in full swing at its most potent level.  What's not as clear is at what point we hit diminishing returns.  Or worse yet, at what point proves too long, where benefits not only cease but potentially begin to backfire.  Among the experts in the field, the consensus is generally anywhere between 2-10 days is a safe bet, with a strong argument made for the notion that the cumulative number of days spent fasting (which one can base on a calendar year, to have a sturdy metric) is more important than the length of each individual endeavor, so long as each fast surpasses the 48 hour mark.  In other words, fasting for 3 days consecutively once per month (which amounts to 36 days for the year) is likely superior to fasting for 10 days, 3 times per year (which would total 30 days).

How to Do It

For starters, one should first consult their physician should they possess any condition whatsoever.  Fasting can be taxing on one's system, and this should not be taken as a blanket recommendation for its use.  Women have historically had more difficulty than men in navigating lengthier fasts, and its not surprising from an evolutionary perspective when we consider that child bearing is likely not ideal when in an under-fed, under-slept, and/or heightened stress state.  Men and women are hormonally quite different, and therefore respond quite different to varying stimuli.  

Even those who feel primed towards engaging in an IF routine or merely stepping one foot into the water should dig much deeper before doing so.  As one who dove in headfirst without much regard for potential pitfalls, I've made almost every mistake in the book, and many of them should be taken quite seriously.  Please reach out (simply by replying to this email) should you wish to pursue fasting but have some trepidation before doing so.  I'm no certified expert, but I can likely point you in the direction of someone who is, if I can't answer your questions myself.  That said, I have accumulated a number of to do's and not to do's, which I've compiled below.  These serve as a nice framework for anyone looking to take the plunge, or for anyone who has had an especially lousy experience when doing so but wasn't sure why.

Do not overdo it with junk food leading into a fast.

The best advice I've received for entering a fast is to shift metabolic gears and enter the fast in a state of nutritional ketosis.  This can take a while for one not well adapted to ketogenic dieting (an approach where the vast majority of macronutrients in the diet are derived from fat), and may be outright impossible if you decide to embark on a fast without much lead time.  Your body will inevitably enter a state of starvation ketosis within 24-48 hours of a fast, as it recalibrates its energy producing mechanisms in the absence of calories.  By stuffing down a huge tray of brownies the night before the fast begins in effort to make the fast easier (by way of making yourself fuller, assuming that you'll be able to last longer without experiences hunger pangs), you're actually doing yourself a disservice.  The exorbitant amount of carbohydrates ingested will merely prolong the time needed to shift into ketosis, and that waiting period is often cited as the most difficult for fasters to endure.  At the very least, eat cleanly and normally in the days leading into a fast.  Were I to take Thanksgiving as an opportunity to rebound with a fast, I would go at least five days of clean eating post-holiday before slipping beginning one.

Prioritize resistance training during a fast.

mTOR works on a variety of different channels, and mTOR in the muscle differs from mTOR in the cells.  We can activate it in the muscle by way of lifting weights, even in the absence of food.  By forgoing strength training, we put ourselves at risk of preferentially shedding muscle mass during the fast, as opposed to shedding primarily body fat.  But don't overdo it with intensity.  Training too aggressively will leave you quite fatigued and potentially lead to an electrolyte imbalance.

Supplement intelligently, namely with electrolytes.

Cramping is a common pitfall of fasting.  Many misunderstand the mechanisms behind cramping, assuming that one simply needs more water.  More water will help, yes, but its the minerals within the water that are the key.  Magnesium and sodium first and foremost, but also calcium and potassium.  By routinely adding these to water (like salt, for example) or simply taking them in pill form, muscle functionality will improve, and you can hedge against not only cramps, but also the potential for heart palpitations.  This mineral supplementation goes hand in hand with the exercise suggestion that came before it.  The more intense the exercise, the more depleted the electrolytes are bound to become, the more supplementation is needed to combat the depletion.  (Note: minerals are devoid of calories.)

Prepare to be cold.

Thyroid function is down-regulated during a fast, leaving many feeling cold.  This is to be expected.  Don't be overly concerned when it begins setting in on Day 2.  Just be prepared to yearn for an additional layer of clothing at certain times throughout the day.

Anticipate rocky sleep.

Everyone seems to have a different experience.  The first time I'd ever gone to bed having not eaten at any point during the day, my sleep was awful.  But during each successive fast, Night 1 sleep was fantastic.  It then became Night 2 where sleep became difficult.  A sudden deprivation of food is quite jarring to the body, and we're understandably jolted into a fight or flight mode, as our body falsely perceives our circumstance as dyer and fights to keep us awake.  Fortunately it does improve with time.  But somewhat magically, cognition on the day following a rocky night's sleep during a fast is seemingly never impaired.  This is attributable to the wakefulness hormone orexin, which kicks into higher gear during a fasted state as an evolutionary mechanism to hedge against starvation.

Bottom line: if you're going to do it, then plan it out and be prepared the bumps along the way.